S9 VPAP Auto Settings

[holden4th]

I've picked up a used Resmed BiLevel from Supplier #2 and am looking at it as an alternative to the PR760 which I've been using. While it has been a step up from APAP, I've never been totally happy with the PR BiPAP and am hoping that the S9 will take my therapy even further. My therapy with the 760 has thrown up anomalous readings and variable results which has prompted me to try the Resmed.

What I need to do is set up the machine and I can only use the PR BiPAP settings as a guide.

With the 760 I had a an IPAP max of 20, EPAP min of 10.5, PS max at 5 and min at 2.5.

Looking at the Resmed there are features/settings that the Respironics doesn't have. For my first night my settings are:

IPAP max 20
EPAP min 9.0
PS 3.6

Now come the unknown (to me) settings: These came preset and I'm assuming that they are default.

Ti Max 2.0
Ti Min 0.3
Trigger Med
Cycle Med

I'm not sure quite how these work but feel that they are important. With the 760, I could feel the machine sort of prompting me to exhale before I wanted to and from what I've read, the above four settings will allow me to resolve this issue if I set them right. I am concerned that the Ti max might not be long enough. I have the impression that the Trigger setting is important but do I need it softer or harder. What does the Cycle setting do.

All advice gratefully received.

[DeepBreathing]

Do you have a copy of the clinician's manual? That gives some information on these settings.  eg:

TiControl ™  – Inspiratory time control

(S, ST and VAuto modes) Unique to ResMed CPAP and bilevel devices, TiControl allows you to set
minimum and maximum limits on the time the device spends in IPAP.  The minimum and maximum time
limits are set at either side of the patient’s ideal spontaneous inspiratory time, providing a ’controlled
period’ for the patient to spontaneously cycle to EPAP.

The minimum time limit is set via the Ti Min parameter and the maximum time limit is set via the Ti Max
parameter.

TiControl’s Ti Max and Ti Min parameters play a significant role in maximizing synchronization by
effectively intervening to limit or prolong the inspiratory time when required. Along with Vsync, this
ensures synchronization even in the presence of significant mouth and/or mask leak.

Triggering and cycling

(S, ST and VAuto modes) Under normal conditions, the VPAP triggers (initiates IPAP) and cycles
(terminates IPAP and changes to EPAP) as it senses the change in patient flow. Patient breath detection
is enhanced by the VPAP’s automatic leak management feature—Vsync.

In addition, the VPAP has adjustable trigger/cycle sensitivity to optimize the sensing level according to
patient conditions.

[Sleeprider]

I think you will find the S9 is faster to respond with higher IPAP/EPAP pressure to obstructive precursors. Pressure support is fixed in the Resmed, but that should not be a problem; just increase for comfort and hypopnea, and decrease for centrals. The Ti min, Ti max, trigger and cycle can be left at default unless you have an issue with the timing. If you decide to experiment with those settings, I would choose one at a time and read the information in the manuals that Deepbreathing referred to, so you understand what the range of settings does. The only one I have changed is Ti max to 2.2 since I have a high-volume inspiration and felt better with more IPAP time. Go slowly and as questions arise, we can discuss them one at a time, but for now I would stick with defaults and the starting settings you adapted from the 750.

On pressure support, you might want to use the 90% from your PRS1 750 rather than the median.

[holden4th]

A good first night with an AHI of 0.26. This consisted of 1 hypopnea and 1 CA. Both were right at the beginning of my sleep and followed each other. The smooth pressure lines are so different from the PR760 (no unexplained spikes) and I think I can see where the machine jumped in very quickly to prevent an event.

Two interesting points:

This machine seems so much easier to breathe with. In hindsight I felt that I had to breathe quite a bit harder with the Respironics - the Resmed seems smooth in comparison.

The leak rate is also improved. I could feel the air being pushed around the edges of the nasal pillow unless I set it just right with the PR. Not so with the Resmed and a leak rate of 13.2 at 90% is a good result.

The PS 90% range with the PR760 ranged between 2.5 (my min setting) and 4.6 with 3.5 being a quite common score so I'll leave my PS at 3.6 for the moment.

OK it's early days but I'm already thinking that I've made a good choice by switching.

[trish6hundred]

Hi holden4th,
It sounds like you are off to a good start with your new machine.
Hopefully, things will continue to go well.